The Marathon:
Laboring and pushing a baby out of your body is an incredibly physical and exertional event akin to a marathon. If you were to go out one day and run a marathon without training for it, your likelihood for completing it in a reasonable time frame, not sustaining any injuries, or reaching a point of exhaustion, would not be nearly as high as if you had conditioned your body first. Of course there are certain factors that are out of your control with your laboring experience, just like weather and uneven terrain can affect your experience with running a marathon. However, chances for progressing through labor, especially the 2nd stage of pushing, have a much higher rate for success with conditioning your body first through pelvic floor physical therapy.
Pelvic floor physical therapy can help you throughout each trimester of pregnancy in a variety of ways. In addition to helping with preparation for laboring and pushing, it can also help with any pain or discomfort you may experience due to all the significant changes happening in your body as your baby grows. The process of participating in pelvic floor physical therapy starts with building the strength in your hips and core that you need for pushing. When pushing your baby out, your pelvic floor also must have the ability to lengthen and "get out of the way" so that you can have the safest delivery possible for both you and your baby. Let's get you to the finish line of that marathon without any injuries! Now.. where do we start?
Training through the trimesters
Starting your pelvic floor physical therapy training program early can help to prepare you the best way possible. While pelvic floor physical therapy can help with any pain or dysfunction you may experience in the first trimester, the work really gets going in the 2nd trimester. The 2nd trimester is when your pelvic floor physical therapist can perform an internal examination of your pelvic floor and assess muscle function. Any tenderness or pain in the pelvic floor muscles should be addressed at this point. Tenderness or "trigger points"in the pelvic floor are common if you have a history of any pelvic dysfunction such as pain with intercourse, leaking urine, or constipation. A history of these symptoms can be indicative of lack of movement in the pelvic floor which means the muscles are not strong enough for a healthy contraction as well as unable to fully relax. Throughout the trimesters of pregnancy you want to make sure your pelvic floor can effectively do both of these actions.
The tone and strength of your pelvic floor is important through the progression of your pregnancy in order to take on the extra stress and pressure it has to manage with the increased weight it must carry throughout the day and with exercise. Strengthening of the surrounding hip musculature is also very important as these muscles function with the pelvic floor and provide a significant amount of support to the pelvis. This strength will also help with the position of the baby's head through the phases of labor, guiding optimal movement as they navigate through the birth canal. Strengthening your pelvic floor simultaneously strengthens your deep abdominals which help with pushing as well as reducing the degree of separation of the external core muscle called your rectus abdominus. This muscle is usually thought of as the "6-pack" muscle in the very front of your stomach that is predisposed to separating as your belly grows. This separation is called diastasis recti and is very common in pregnancy. The best way to reduce the likelihood and severity of diastasis recti is through pelvic floor strengthening and learning other strategies and safe ways of transitioning by working with a pelvic floor physical therapist. All of this strengthening and training helps throughout pregnancy, but all comes back around to improving your ability to push your baby out when the time comes.
The Push
In the third trimester the training to push begins and you will learn from your pelvic floor physical therapist the best way to do this for your own individual body and to suit your ideal birth plan. They will train you on the best breathing techniques as well as how to relax and lengthen your pelvic floor so that the baby can more easily be pushed out with reduced trauma to the pelvic floor. There are a variety of positions this can be performed in and you can practice each to see which seems to work best for you. Your physical therapist is able to check intra-vaginally to see how much your pelvic floor is lengthening and moving downward when you push. You don't want to have your pelvic floor contract upwards or stiffen when you practice pushing as this will be counter productive in allowing the baby to pass through the opening in the pelvic floor. Additionally, your physical therapist can help teach you how to perform perineal stretching. This technique helps to mobilize the thick band of tissue across the middle of your pelvic floor which typically has the most difficulty lengthening. Perineal stretching can help to reduce the risk of tearing your pelvic floor as well as help you to more effectively push your baby out. There are countless other ways a pelvic floor physical therapist can help you achieve success in pregnancy and labor. Remember that marathon you are training for and reach out to a pelvic floor physical therapist to guide you in this process.
Finding a physical therapist
The journey of pregnancy and delivering your baby is the most physically challenging event you are likely to experience in your life time, so it should make total sense that a physical therapist can help you to prepare for it. You want to take care when you are searching for a pelvic floor physical therapist that they are the appropriate clinician for you. They should not only be trained in pelvic floor physical therapy, but additionally trained in pregnancy and post-partum rehabilitation. This will ensure you are getting the best guidance and most appropriate exercises and education to prepare you. It can be challenging to get in with a pelvic floor physical therapist in the time-frame you need because it is in higher and higher demand these days. Try to get scheduled out with one as soon as possible in your first trimester so that they are able to get you in in your second and third trimesters for labor prep. Remember that you can also go in earlier if you are having physical symptoms or pain.
Additionally, don't forget to schedule your first post-partum appointment as early as possible either before or after your delivery. Most of the time this appointment is scheduled to occur at the 6 week post-partum mark. However, you can come in earlier to start working on some foundational core and breathing exercises as early as 2 weeks. The only difference is that an internal examination is not performed until after your OB clears you at your 6-week check-up. Whether you experience minimal trauma to your pelvic floor during your delivery, end up with tearing to these muscles, or a C-section, you still want to come in for post-partum physical therapy. This will ensure you are getting back to all of your activities as safely and quickly as possible.
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